BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Previous studies have reported abnormal amplitude of low-frequency fluctuation and regional homogeneity in patients with migraine without aura using resting-state functional magnetic resonance imaging. However, how whole brain functional connectivity pattern homogeneity and its corresponding functional connectivity changes in patients with migraine without aura is unknown. In the current study, we employed a recently developed whole brain functional connectivity homogeneity method to identify the voxel-wise changes of functional connectivity patterns in 21 patients with migraine without aura and 21 gender and (...) age matched healthy controls. Moreover, resting-state functional connectivity analysis was used to reveal the changes of corresponding functional connectivities. FcHo analyses identified significantly decreased FcHo values in the posterior cingulate cortex, thalamus, and left anterior insula in patients with migraine without aura compared to healthy controls. Functional connectivity analyses further found decreased functional connectivities between PCC and medial prefrontal cortex, between AI and anterior cingulate cortex, and between THA and left precentral gyrus. The functional connectivities between THA and PCG were negatively correlated with pain intensity. Our findings indicated that whole brain FcHo and connectivity abnormalities of these regions may be associated with functional impairments in pain processing in patients with migraine without aura. (shrink)

本书侧重从中国古代政治史、思想史、文化史和文学史的结合方面,研究和探讨了中国古代德治思想与文士文学的关系。.

With the prevalence of the Internet and new media channels, consumer reviews have become one of the main determinants of Consumers’ purchasing decisions. This paper uses the Latent Dirichlet Allocation model to identify the key factors that are of major concern to consumers, including design factors, laptop setup factors, logistics factors, after-sales factors, and user experience factors. And, we classify these factors into product quality factors and supporting service factors for new products. We then explore the relationship between online reviews (...) and purchase decisions under these different factors, and also further explore the impact of interactions between online review metrics on purchase decisions. Our findings suggest that the impact of online reviews on consumer purchase decisions also varies considerably across different consumer focus factors. In addition, we find that the impact of the interaction between online review features is complex. In particular, consumers do not follow the positive guidance and make purchase decisions as we would expect when confronted with a large number of positive emotional polarity online reviews. Meanwhile, the interaction between negative emotional polarity and variance of online reviews had no significant effect on consumer purchase decisions. The variance of online reviews has a limited role in reducing consumer risk perceptions triggered by negative emotional polarity. Our study provides new evidence for the study of the impact of online reviews through text mining. (shrink)

Migraine is a chronic and idiopathic disorder leading to cognitive and affective problems. However, the neural basis of migraine without aura is still unclear. In this study, dynamic amplitude of low-frequency fluctuations analyses were performed in 21 patients with migraine without aura and 21 gender- and age-matched healthy controls to identify the voxel-level abnormal functional dynamics. Significantly decreased dALFF in the bilateral anterior insula, bilateral lateral orbitofrontal cortex, bilateral medial prefrontal cortex, bilateral anterior cingulate cortex, and left middle frontal cortex (...) were found in patients with migraine without aura. The dALFF values in the anterior cingulate cortex were negatively correlated with pain intensity, i.e., visual analog scale. Finally, support vector machine was used to classify patients with migraine without aura from healthy controls and achieved an accuracy of 83.33%, sensitivity of 90.48%, and specificity of 76.19%. Our findings provide the evidence that migraine influences the brain functional activity dynamics and reveal the neural basis for migraine, which could facilitate understanding the neuropathology of migraine and future treatment. (shrink)

Since the COVID-19 pandemic, the tourism economy has been seriously affected. China has implemented a direct traveling management mechanism and recovered from the pandemic faster than the rest of the world. However, the COVID-19 situation is complicated and uncontrollable because of the available unclear information including difficult medical terminologies. This study attempts to find the determinants of the travel intention of China’s tourists in the post-COVID-19 epidemic. Along with information overload and perception risk, an expanded research model of the Theory (...) of Planned Behavior was employed to propose the theoretical framework of this study. A survey was conducted among 518 tourists who spend their holiday in Hainan, which is a popular tourist destination in China. The empirical results show that information overload positively and significantly impacted perceived risk. Furthermore, perceived risk negatively affects the intention to travel. Perceived risk also negatively affected the attitude toward traveling. However, response self-efficacy did not have a significant effect on the intention to travel. Finally, based on the analysis results, this study proposes relevant research contributions and practical recommendations with management implications for the travel industries. (shrink)